The Lancet, one of the world’s oldest and best-known medical journals, has blasted a widely-publicized report that said e-cigarettes are 95% safer than regular, combustible tobacco.

“Tobacco is the largest single cause of preventable deaths in England—e-cigarettes may have a part to play to curb tobacco use. But the reliance by PHE on work that the authors themselves accept is methodologically weak, and which is made all the more perilous by the declared conflicts of interest surrounding its funding, raises serious questions not only about the conclusions of the PHE report,” writes the Lancet editorial team.

The report, from Public Health England, said that e-cigarettes can help smokers quit and are 95% less harmful than regular cigarettes.

“Many people think the risks of e-cigarettes are the same as smoking tobacco and this report clarifies the truth of this. In a nutshell, best estimates show e-cigarettes are 95% less harmful to your health than normal cigarettes, and when supported by a smoking cessation service, help most smokers to quit tobacco altogether,” said the report.

“Smokers who have tried other methods of quitting without success could be encouraged to try e-cigarettes (EC) to stop smoking and stop smoking services should support smokers using EC to quit by offering them behavioral support. Encouraging smokers who cannot or do not want to stop smoking to switch to EC could help reduce smoking related disease, death and health inequalities. There is no evidence that EC are undermining the long-term decline in cigarette smoking among adults and youth, and may in fact be contributing to it. Despite some experimentation with EC among never smokers, EC are attracting very few people who have never smoked into regular EC use,” it says.

But The Lancet calls into question the report, saying the papers it is based upon are faulty at their core.

“[N]either PHE nor McNeill and Hajek report the caveats that Nutt and colleagues themselves emphasised in their paper. First, there was a “lack of hard evidence for the harms of most products on most of the criteria”. Second, “there was no formal criterion for the recruitment of the experts”. In other words, the opinions of a small group of individuals with no prespecified expertise in tobacco control were based on an almost total absence of evidence of harm. It is on this extraordinarily flimsy foundation that PHE based the major conclusion and message of its report.”

“The study led by Nutt was funded by Euroswiss Health and Lega Italiana Anti Fumo (LIAF). Riccardo Polosa, one of the authors of the Nutt paper, is the Chief Scientific Advisor to LIAF. In the paper, he reports serving as a consultant to Arbi Group Srl, an e-cigarette distributor. His research on e-cigarettes is currently supported by LIAF. Another author reports serving as a consultant to manufacturers of smoking cessation products. The editors of the journal added a note at the end of the paper warning readers about the “potential conflict of interest” associated with this work.”

We’ve published more info on estimate that e-cigarette use is around 95% less harmful than smoking http://t.co/HWs1n4SyYH

— PublicHealthEngland (@PHE_uk) August 28, 2015

PHE has responded, standing by its findings.

“We concluded that these new studies do not in fact demonstrate substantial new
risks and that the previous estimate by an international expert panel (Nutt et al,
2014) endorsed in an expert review (West et al, 2014) that e-cigarette use is
around 95% safer than smoking, remains valid as the current best estimate based
on the peer-reviewed literature,” says PHE.

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